Provider Demographics
NPI:1942225974
Name:STEWART, OLIVIA DEHAVILLAND (LPC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:DEHAVILLAND
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 GRINDENWALD DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-8037
Mailing Address - Country:US
Mailing Address - Phone:770-912-3634
Mailing Address - Fax:678-610-1633
Practice Address - Street 1:137 W MILL ST STE F
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3572
Practice Address - Country:US
Practice Address - Phone:770-835-5527
Practice Address - Fax:678-545-2390
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
GALPC 004134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA477163794AMedicaid